Special report on HIV/AIDS and drug addiction - Continued

CASE HISTORIES Inside the resource-strapped facility, with its 80-bed capacity already overstretched, health workers tend to the needy as best they can. In one ward, four women, all former addicts and all HIV positive, tell similar stories of how they became infected. "Once I tried it [crack] I couldn’t stop," Sveta Zharkova told IRIN. "After I lost my job at the steel factory there was nothing else to do." For nine years the mother-of-two used crack as her preferred choice over heroin, and at a cost of slightly more than one US dollar per dose, it was not hard to understand why. "I never used heroin, [only crack]," 24-year-old Ira Rudenko explained as she coughed phlegm into a jar placed by her bed. "I continued to use drugs because I no longer cared about myself." Although aware of her HIV status since 1998, the unemployed woman continued shooting up until just last year, but "I never gave my needle to anyone else. Usually we addicts tell each other about our HIV status," she said. Despite such claims, however, the government of Kazakhstan is taking the issue of needle exchange seriously, with some 122 exchange points established country-wide. In Termirtau alone, up to 200 people a day visit one of six centres in the city, which hand out over 12,000 needles a week. Today, each year close to two million syringes are being distributed nationwide. A NEW THREAT OF TRANSMISSION According to the US-sponsored Centre for Disease Control (CDC) in Almaty, such efforts are having an impact, and the number of new HIV cases affecting IDUs has dropped - a fact government statistics confirm. "In the last two years, the picture has changed and the rate of infection among intravenous drug users has decreased from a high of 90 percent to a present rate of 83 percent," Bekzatov explained. Whereas at first glance this statistic might represent a positive development, it becomes less significant when coupled with the fact that the rate of infection through sexual transmission has risen from 5 percent to 9 percent, and the rate is continuing to rise. "This is a dangerous trend," Bekzatov noted. "The general public is now more at risk than before."

Dr Sholpan Baimurzina outside the Temirtau AIDS centre

Describing this as "petrol" being spilled across the country, he warned: "One match and it could ignite. We need to start changing our behaviour across the board - not just among IDUs." Given the rise in the number of sexually transmitted cases, he stressed the need for intensive action to raise awareness among commercial sex workers, something that the government has taken on board. GOVERNMENT EFFORTS At the end of 1995, the government developed a special national strategic plan, and since 1996, the Multi-sectoral Coordination Committee on HIV/AIDS Prevention has been operational under the prime minister's office, and is chaired by the deputy prime minister himself. The committee comprises key ministries and agencies, NGOs, people living with HIV/AIDS and representatives of international organisations. Moreover, in 2000, it reformed its policy on ways of countering the disease's spread through 2005, identifying three priority groups: IDUs, commercial sex workers and youth. "It is no longer looked upon as just a medical problem, but a multi-dimensional social problem," Bekzatov explained. A 1994 law on AIDS prevention guarantees the rights of people living with HIV and of representatives of vulnerable groups, stipulating that the government must provide free treatment and social protection for HIV-infected people, to supply the population with HIV/AIDS information and to perform required prevention interventions. However, despite these efforts, much more is needed in combating the problem, making it unlikely that the government will succeed in containing, let alone reversing, the spread of the virus by 2015 - one of the nation's eight millennium development goals. Continued